Company Name                                                                                          

Address                                                                                                        

City                                State                               Zip Code                         

Phone #                          Fax #                              Email                             

Billing Address (if different)                                                                          

City                                State                               Zip Code                          

Accounts Payable Contact                                               Phone #              

Type of Business (check all that apply):

( )  Proprietorship            ( ) Partnership                 ( ) Corporation             

( ) Restaurant/Caterer      ( ) Hotel/Institution          ( ) Other                       

References

Bank                                                  Account #                                           

Address                                                                                                        

City                                State                               Zip Code                         

Phone #                                             Contact Name                                   

Trades

Name                                                 Account #                                         

Address                                                                                                        

City                                State                               Zip Code                          

Phone #                                             Contact Name                                    

Name                                                 Account #                                           

Address                                                                                                         

City                                State                               Zip Code                           

Phone #                                             Contact Name                                     

Name                                                 Account #                                           

Address                                                                                                          

City                                State                               Zip Code                           

Phone #                                      Contact Name                                            

Has your company ever filed Bankruptcy?                                                   

Parties hereby agree that purchases made are subject to the following terms and conditions:

The undersigned purchaser hereby agrees that all amounts due for goods and services purchased from the product group will be paid in full.

The undersigned purchaser hereby agrees that all amounts due the product group are payable within credit terms. If any amount due is not paid within said time period a delinquency charge of 1½ %  per month of the delinquent balance will be added to the total amount due but will not exceed 18% per annum.

The undersigned purchaser agrees to pay The Product Group, Inc. a service charge of $18.00 for all returned checks.

In the event that the account becomes delinquent the undersigned purchaser agrees to pay attorney fees of 33 1/3 % of the account balance and all collection fees. 

The undersigned agrees to notify The Product Group, Inc. by certified mail of any change of ownership and further agrees to be liable for all purchases should the undersigned fail to comply with said notification.

The parties hereby acknowledge that the goods and/or services purchased from The Product Group, Inc. are not payable in installments, but are payable in full as stated herein.

The undersigned agrees and gives permission for The Product Group, Inc. to obtain and verify credit references to consider this application.

In the event that this guaranty is executed by more than one person, the liabilities and obligations of the undersigned hereunder shall be joint and several and the relative words herein shall be read as if written in plural.

Date                                                   Signature                                             
                                                                         (Officer, Owner or Partner)

Title                                                        

Print Name                                             

(For this application to be given proper consideration, all questions must be answered, and signed by Officer, Owner or Partner)

Please fax to:  330-477-8599